Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 0101038080 | VA |
NPI | 1104846898 |
---|---|
Provider Name | Dr. Jean E Teasley |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-0599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10136814 | (05) | VA |
E32968 | (02) |